Fractures of the Femoral Head

Abstract

Fractures of the femoral head are not frequent and are almost always combined with dislocation of the hip. We reviewed 43 cases of femoral head fractures (33 men, 10 women), mean age 38.6 years. Using Pipkin's classification there were 13 type 1 cases, 5 type 2 and 25 type 4. Twenty-nine patients (67.4%) were seen again after a minimum of two years. Overall, there were ten excellent results, nine good, four fair and six poor. Complications were three cases of ischemic necrosis, eleven secondary arthritis, and three cases of heterotopic ossification. CT is an extremely useful method for assessing these lesions, especially in cases with small intra-articular fragments (Pipkin 1 and 4). Therapeutic indications obtained from this study were a non-invasive approach for Pipkin type 1 lesions, except those with a large intra-articular fragment, surgery for Pipkin type 2 cases, with osteosynthesis of the fragments, mainly using Herbert screws, and surgery particularly for Pipkin type 4, especially for osteosynthesis of the fragments of acetabular wall.